Purpose: :
To evaluate the corneal characteristics of patients who underwentLASIK and presented with diffuse lamellar keratitis (DLK) after4 days using in vivo laser confocal microscopy and anteriorsegment OCT.

Results: :
The visual acuity at the first visit was 20/40 in 3 eyes, 20/60in 1 eye and 20/80 in 1 eye. Slit-lamp examination revealeddiffuse, multifocal and granular haze in the stroma underneaththe flap. Anterior segment OCT revealed a hyperreflective line150 µm beneath the epithelium corresponding top the flapand a diffuse hyperreflective tissue above and under the stroma.Confocal microscopy demonstrated multiple dendritic cells inthe basal layer (mean density 12±4.2 cell/mm2), highreflectivity of the extracellular matrix and a reduction ofkeratocytes in the anterior stroma. The subepithelial nerveplexus was not visualized, the posterior stroma and the endotheliallayer was within normal limits. After intense treatment withtopical steroids DLK resolved and corneal transparency was achievedwith complete restoration of visual acuity. At the last visitvisual acuity was 20/20 in all eyes, anterior segment OCT revealeda hypereflective line, corresponding to the flap while the stromahad homogeneous reflection. Confocal microscopy demonstrateda reduction of dendritic cells and a reduction of the reflectivityof the extra-cellular matrix of the residual stroma.

Conclusions: :
DLK is a rare complication that may occur in patients who underwentLASIK. Anterior segment OCT and confocal microscopy might beimportant tools in the diagnosis and follow up of this disease.